Block 1 H&S

What is a population perspective?

Considering whole population

Complements focus on individual

Sometimes conflicts with interests of individual

In what ways may an understanding of health in populations influence the practice of a doctor?

• Understand cause of disease

• Know what treatment works

• Improve health

How can health be defined?

• Negatively - the absence of illness

• Functionally - the ability to cope with everyday activities

• Positively - fitness and wellbeing

What is incidence?

The number of new cases of a disease, divided by the total population at risk by the time interval

What is prevalence?

The total number of individuals who have an attribute or disease at a particular time or during a particular period, divided by the total population at risk

What are the major causes of illness and death in UK adults?

• Circulatory disease

• Cancer

• Respiratory disease

What are the major causes of illness and death in UK children?

• Infection

• Poisoning

• Cancer

What are the major causes of illness and death in the developing world?

• Cholera

• Malnutrition

• Malaria

• Diarrhoea

• Pregnancy complications

• Neonatal death

• Infection

• AIDS

What factors led to changes in life expectancy in the developed world over the last century?

• Creation of safe water and sewage disposal systems

• Control of disease-bearing insects and rodents

• Immunisation programs

• Improved nutrition

What is a population pyramid?

Two back-to-back graphs, showing the number of males and females in a population in five-year age groups

Males are conventionally on the left, and they may be measured by raw number or as a percentage of the total population

What is the typical population distribution for the UK?

• Rectangular

• Narrow base - relatively few children and young people

• Lack of change in size between consecutive age groups - very few people die until they reach old age

• Typical of a more economically developed country - low birth and death rates, long life expectancy, wide use of contraception, good public hygiene, good healthcare

What is the typical population distribution for a less economically developed country?

• Triangular/pyramidal

• Wide base - large number of children

• Rapid narrowing - many people die between age bands

• Typical of a LEDC - high birth and death rates, short life expectancy, little access to or incentive to use contraception, poor public hygiene, often lack of clean water, little access to healthcare

How is stillbirth rate calculated?

Number of infants stillborn with a gestational age of at least 24 weeks per 1000 total births

How is neonatal mortality calculated?

Number of deaths within the first 28 days per 1000 births

How is infant mortality calculated?

Number of deaths within 1 year of life per 1000 births

How do fertility and mortality differ between the developed and developing world?

Fertility and mortality are higher in the developing world

How is Evidence Based Decision Making implemented?

• Evidence based clinical guidelines

• Summaries of evidence provided for practitioners

• Access to reviews of research evidence

• Practitioners evaluating research

What forms of information do doctors use?

• Research evidence

• Clinical experience

• Available resources

• Patient preferences

What is the definition of evidence?

An observation, fact or organised body of information offered in support of and to justify inferences or beliefs in a demonstration of some proposition or matter at issue

Why is Evidence Based Decision Making important?

• Way of dealing with uncertainty

• Incomplete medical knowledge

• Expanding quantity of medical facts

• Shifting and revising medical knowledge

• Need for innovation and improvement

• Ensure patients receive most appropriate treatment proven by research

• Improving efficiency

What are examples of aspects of medical practice affected by uncertainty?

• Diagnosis and treatment

• HRT

• Mammograms

• Cancer treatment

How is the NHS organised?

• Taxpayers - fund

• Department of Health - set policy, strategy and standards

• 7 Regional Teams - responsible for the quality, financial, and operational performance of all NHS organisations

• 42 Integrated Care Systems - manage performance

• 1250 Primary Care Networks - groups of GP practices working together with community, mental health, social care, pharmacy, hospital, and voluntary services

• 217 Hospital NHS Trusts - give secondary and tertiary care

• Patients and public

What user charges are there in the NHS?

• Prescription charges

• Dental care

• Ophthalmic care

Where does most of the finance for the NHS come from?

• General taxation (85%)

• National insurance contributions (10%)

• User charges (5%)

How is healthcare financed in the US?

Medicare and Medicaid available to the very poorest

How is healthcare financed in Italy?

Mostly state provided

How is healthcare financed in France?

• Not free at point of delivery

• Patient must pay and is later refunded

• Some is totally refunded, some partially

• Every treatment has a recommended price

What are the main functions of the GMC?

• Controls UK medical register

• Sets standards in undergraduate education, clinical practice and behaviour

• Responsible for audits of UK medical schools and for the continuing professional development of practicing doctors

• Continuing revalidation of doctors

Who is responsible to the GMC?

All medical students and doctors

What sanctions can the GMC apply?

• Warning

• Conditions of license

• Suspension

• Removal from register